The proposed research will be the first large prospective study of the psychological consequences associated with failure (particularly repeated failure) of assisted reproductive technologies (ARTs). Although there has been much concern about how ART failures affect individuals and couples, the current research literature contains more gaps than answers. The specific aims of this research are to: 1) determine the extent of psychological and marital distress and of clinically diagnosable psychiatric disorders ("psychological outcomes") in patients and their husbands following ART failure(s), 2) compare the psychological outcomes of patients and their husbands who remain childless after ART failure(s) to those who experience other treatment and child-related outcomes, including not pursuing ART, adopting a child, and having a child as a result of treatment and 3) use a vulnerability-stress model to predict which patients and husbands will experience poor psychological outcomes in response to ART failure(s) so that those individuals can be targeted for supportive interventions. A cohort of 620 couples seeing an ART physician for an initial consultation for their first ART cycle will be interviewed and followed over the subsequent 18 month period regardless of their treatment trajectory. All cohort members will participate in an initial interview prior to any ART attempts during which individual vulnerability factors will be assessed. All cohort members will then participate in a post-results interview two weeks after their first cycle if one is initiated, and follow- up interviews 6, 12, and 18 months later, during which psychological outcomes will be assessed. Those not initiating ARTs within 3 months of the initial interview will be re-interviewed 6, 12, 18 months later. The findings of this study will guide the development of assessment and intervention protocols for couples using and considering ARTs.